Gynecological Cancer

PV QA 4 - Poster Viewing Q&A 4

TU_20_3511 - Disparities in Uterine Cancer Treatment and Survival Among African American and White Women in the United States

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Disparities in Uterine Cancer Treatment and Survival Among African American and White Women in the United States
L. P. Cho, and A. N. Viswanathan IV; Johns Hopkins Hospital, Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, MD

Purpose/Objective(s): To examine racial disparities in receipt of post-operative radiation therapy and overall survival for stage I-III endometrial cancer patients.

Materials/Methods: The National Cancer Data Base (NCDB) was searched for African-American (AA) and Caucasian/White (CW) endometrial cancer patients with FIGO Stage IB-IIIC who underwent surgery. A univariate model was used to estimate the odds of receiving radiation therapy (RT), and multivariable cox proportional hazard regression models were used to estimate the instantaneous hazard of all-cause mortality for those receiving no radiation versus any radiation and for the association between race and overall mortality. Actuarial survival estimates and plots were generated using the Kaplan-Meier method and compared using the log rank test.

Results: 33,998 patients were identified: 90% white, 54% government-sponsored insured, 41% median income < $48,000, 95% Charlson-Deyo (CD) comorbidity score≤1, 48% stage I, 16% stage II, and 37% stage III. In the univariate logistic regression (LR), age 70-79 and 80+ (vs. < 70), AA women, median income ≥$38,000 (vs. <$38,000), diagnosis year 2012-2013 (vs. 2010-2011), FIGO stage II (vs. stage I), negative peritoneal cytology (vs. no test), negative pelvic lymph nodes (vs. no teste), negative para-aortic lymph nodes (vs. no test) were all significant predictors of receipt of RT. The odds of receipt of RT was 0.78 for AA compared to CW in the univariate logistic regression (p<0.001). Stage was the only statistically significant variable in the multivariate LR for receipt of post-operative RT (p<0.001). Univariate Cox proportional hazards showed that AA women compared to CW women had poorer survival (HR 1.95, 95% CI 1.82-2.09). Similarly, those with CD ≥1, diagnosis year 2012-2013, stage ≥ II, grade ≥2, lymphovascular invasion, positive peritoneal cytology, positive pelvic nodes, positive para-aortic nodes, and chemotherapy had poorer survival than their counterparts (p<0.01). Post-operative RT (EBRT and/or BT) was associated with reduced risk of overall survival (OS) (HR 0.76, 95% CI 0.71-0.80), while the use of chemotherapy was not statistically significantly associated with OS (HR 1.35, 95% CI 1.23 -1.42). Compared to women with no receipt of RT, those who received only BT (vs. EBRT and/or CT) had the lowest HR (HR 0.44, 95% CI 0.40-0.49). The log-rank test for the Kaplan-Meier estimates showed a statistically significant difference in survival with 30% deaths among AA and 17% deaths among CW women (p<0.001). The 2-year survival rate is 89% for CW and 79% for AA (p<0.001).

Conclusion: African American women in this analysis were less likely to receive radiation, and more likely to die of endometrial cancer than non-AAs. Future studies should attempt to understand the causes for this disparity in treatment and survival.

Author Disclosure: L.P. Cho: None. A.N. Viswanathan: None.

Send Email for Linda Cho


Assets

TU_20_3511 - Disparities in Uterine Cancer Treatment and Survival Among African American and White Women in the United States



Attendees who have favorited this

Please enter your access key

The asset you are trying to access is locked. Please enter your access key to unlock.

Send Email for Disparities in Uterine Cancer Treatment and Survival Among African American and White Women in the United States